Clinical presentation, diagnostic pathway, treatment patterns, and survival among women with cytologically diagnosed breast cancer in two national referral hospitals in Niger: A five- year retrospective multicenter cohort study
This five-year retrospective multicenter cohort study of 674 women in Niger reveals that breast cancer is characterized by late-stage presentation and significant gaps in pathological confirmation and treatment access, resulting in poor survival outcomes that highlight the urgent need to strengthen early diagnosis, expand diagnostic services, and improve care continuity in resource-constrained settings.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Breast cancer is a disease where cells in the breast grow out of control, forming a lump that can spread to other parts of the body if not treated. In wealthier nations, doctors often catch this disease early through screening programs and use a combination of surgery, drugs, and radiation to cure it. However, in many low-resource countries, the path to a cure is blocked by delays. Women often wait a long time before seeing a doctor, and when they finally do, the cancer has usually grown large and spread. Without access to specialized labs to test the exact type of cancer or machines to deliver radiation, doctors must rely on simpler methods to make decisions. This creates a difficult situation where the treatment available does not always match the specific needs of the patient.
In Niger, a country in West Africa, researchers recently looked back at five years of medical records to understand exactly how breast cancer affects women there and what happens to them after diagnosis. They focused on two major hospitals in the capital city, Niamey, which serve as the main referral centers for the entire country. The team studied 674 women who were diagnosed with breast cancer between 2020 and 2024. Their goal was to trace the journey of these patients from the moment they first noticed a symptom, through the tests they received, the treatments they got, and their survival over time. What they found paints a clear picture of a system struggling under the weight of late detection and limited resources, yet still trying to provide care.
The story of these women begins with a long wait. On average, a woman waited seven months between first noticing a problem in her breast and seeing a qualified medical professional. By the time they arrived at the national hospitals, the disease had progressed significantly. Seven out of ten women were diagnosed with advanced cancer that had already spread to nearby lymph nodes or other parts of the body. Most of these women were relatively young, with a median age of 45, and many had never attended school or lived in rural areas far from the city. The most common reason they came to the hospital was a lump they could feel, though some arrived with pain or open sores on the breast.
Once at the hospital, the path to a diagnosis was swift but incomplete. Every single woman in the study received a fine-needle aspiration cytology test, a procedure where a thin needle is used to pull out a few cells from the lump to check for cancer. This test confirmed the diagnosis for everyone. However, the next step, which is standard in many parts of the world, was largely missing. Only about one-quarter of the women had their tissue examined by a pathologist under a microscope to determine the exact type of cancer. Even more striking, no woman in the entire group had their cancer tested for specific biological markers that would tell doctors which drugs would work best. Without these tests, doctors could not know if a patient's cancer was driven by hormones or a specific protein, leaving them to guess at the best treatment plan.
Despite these diagnostic gaps, the hospitals provided treatment to the majority of the women. About three-quarters of the patients underwent surgery, with the most common operation being the removal of the entire breast and nearby lymph nodes. Most of the women also received chemotherapy, a treatment using powerful drugs to kill cancer cells. The most common drug combination used was a mix of three medicines given over several months. However, other critical treatments were much harder to access. Only about one-third of the women received radiation therapy, which uses high-energy beams to kill remaining cancer cells, and only about one-third received hormone-blocking pills. No one received targeted therapies designed for specific types of breast cancer because the necessary testing was unavailable.
The researchers followed these women to see how they fared. Over the course of the study, about 61 percent of the women were still alive at their last check-up, while about 10 percent had passed away. Unfortunately, nearly 30 percent of the women disappeared from the records before the study ended, meaning the doctors did not know if they were alive or dead. This high rate of people being lost to follow-up makes it difficult to know the true survival rate, but the data that was available showed a clear pattern: women who arrived with advanced cancer had a much harder time surviving than those who arrived early. The study also noted that many women stopped their chemotherapy before finishing, often due to side effects or financial difficulties, which likely reduced their chances of recovery.
The researchers concluded that the main problem in Niger is not a lack of willingness to treat cancer, but a lack of the right tools and systems to do it effectively. The hospitals are doing their best to perform surgery and give chemotherapy, but the absence of detailed lab tests and radiation machines means they cannot tailor the treatment to the individual patient. The long delays before women seek help, combined with the high cost of diagnostic tests that patients must pay for themselves, mean that most arrive too late for the best outcomes. The study suggests that to save more lives, the country needs to invest in making pathology labs and radiation therapy more available, and to help women get diagnosed earlier. Until these gaps are filled, the fight against breast cancer in Niger will remain an uphill battle, where the best available care is often not enough to overcome the disease.
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